| NPI | 1992449078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0030476) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: OH RN.449223) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-11-21 |